f 


LETTER 


FROM 


DOCTOR  EDWARD  JENNER, 

TO 

/ 

WILLIAM  DILLWYN,  Esq. 

ON 


THE  EFFECTS  OF  VACCINATION, 

IN 

Preserving  from  the  Small-Pox . 


TO  WHICH  ARE  ADDED 

SUNDRY  DOCUMENTS  RELATING  TO  VACCINATION, 

t 

referred  to  and  accompanying  the  letter. 


PUBLISHED  BY  THE  PHILADELPHIA  VACCINE  SOCIETY. 
William  Fry,  Printer. 

1818. 


INTRODUCTION. 


THE  importance  of  the  following  Letter,  lately  received 
from  London,  has  induced  the  Philadelphia  Vaccine  Society 
to  publish  it  in  its  present  form.  The  communication  was  made 
in  answer  to  the  enquiry  of  one  of  our  fellow  citizens,  who  was 
desirous  of  knowing  Dr.  Jenner’s  opinion  of  his  truly  inte¬ 
resting  discovery,  after  it  had  stood  the  test  of  twenty  years’ 
experience.  The  friends  of  humanity  will,  no  doubt,  be  highly 
gratified  by  this  additional  confirmation  of  the  security  to  be 
obtained  against  the  ravages  of  the  Small-Pox,  one  of  the  most 
loathsome  and  desolating  of  all  diseases. 


LETTER 


To  Wm.  Dillwyn,  Esq.  High  am  Lodge,  Walthamstow , 

Essex. 

Dear  Sir, 

It  is  a  curious  and  most  delightful  fact,  that  while  the  dis¬ 
putations  you  allude  to  are  here  and  there  going  on  among 
individuals,  with  regard  to  the  efficacy  of  Vaccination,  the 
small-pox  is  flying  before  it  in  all  directions.  In  a  wide  dis¬ 
trict  around  me,  embracing  the  most  populous  part  of  the 
county  of  Gloucester,  which  abounds  with  manufactories,  the 
small-pox  is  scarcely  ever  heard  of;  and  if  it  does  happen  to 
appear  from  infection  brought  by  the  wandering  pauper,  it 
either  finds  itself  insulated,  or  is  rendered  incapable  of  spread¬ 
ing,  by  giving  immediately  the  vaccine  security  to  those  within 
its  atmosphere  who  may  happen  to  remain  unprotected.  In 
these  few  words,  sir,  I  think  I  have  answered  the  main  part,  of 
your  letter;  but  I  will  add  a  few  more;  and  you  have  my  full 
consent  to  transmit,  what  I  say,  to  your  friends  either  on  this 
or  the  other  side  of  the  Atlantic.  Wherever  Vaccination  has 
been  universally  practiced,  there  the  small-pox  ceases  to  ex¬ 
ist.  It  matters  not  how  wide  the  district  or  how  populous  the 
city,  the  result  is,  and,  from  the  nature  of  things,  must  be  the 
same.  There  is  scarcely  any  part  of  the  civilized  world  that 
cannot  bear  testimony  to  the  truth  of  this  position.  For  ex¬ 
tent  of  territory,  we  may  turn  our  eyes  to  our  possessions  in 
the  East,  and  to  various  parts  of  South  America;  and  to 
towns  and  cities,  many  of  the  most  conspicuous  in  Europe. 
As  a  cheering  document,  with  regard  to  the  extinction  of  the 
small-pox  throughout  a  kingdom,  I  shall  take  the  liberty  of 
enclosing  the  report  from  Sweden.*  Now,  as  the  good  sense 
of  the  Swedes  directed  them  to  employ  Vaccination  for  bring¬ 
ing  about  this  great  event,  why  should  not  Britain  avail  her¬ 
self  of  this  great  gift,  and  employ  it  in  a  similar  way?  Here 
the  Boon  is  distributed  with  a  partial  and  sparing  hand,  and 
consequently  the  small-pox  still  exists  in  several  parts  of  our 
island.  However,  I  have  the  happiness  to  say,  that  since  the 


*  See  Appendix,  No.  I. 


4 


first  promulgation  of  my  discovery,  in  the  year  1798,  the 
deaths  by  small-pox  in  the  British  realms,  according  to  the 
best  estimate  1  can  form,  are  reduced  from  more  than  40,000, 
to  less  than  6,000.  The  metropolis,  for  the  last  ten  or  twelve 
years,  exhibited  a  reduction  of  about  one  half  only;  but  during 
the  last  two  years,  Vaccination  has  been  more  extensively 
practiced  than  ever,  both  from  the  benevolence  of  private  in¬ 
dividuals  of  the  Faculty,  and  the  public  institutions;  and  this 
year  promises  a  far  greater  reduction  in  the  number  of  deaths 
than  any  that  has  preceded  it.  You  may,  perhaps,  at  the  India 
House,  have  acquaintances  who  will  furnish  you  with  copies  of 
their  reports  from  Calcutta,  Bombay  and  Madras.  A  copy  of 
one  of  these  I  have  enclosed,  that  it  may  be  seen  with  what 
vigour  the  new  inoculation  was  prosecuted  in  a  country  too 
distant  for  the  approach  of  prejudice.  In  the  island  of  Ceylon, 
the  ravages  were  dreadful,  although  many  efforts  had  been 
made  to  lessen  its  fatality  by  variolous  inoculation.  This, 
wherever  it  was  practised,  produced  a  spreading  of  the  dis¬ 
ease,  and  made  a  bad  matter  worse;  so  that  the  people  would 
have  nothing  to  do  with  it.  But  after  a  little  time,  they  took 
to  the  Vaccine  very  readily;  and  by  referring  to  Dr.  Christie’s 
publication  on  the  subject,  which  you  may  find  at  any  of  the 
medical  booksellers,  you  will  observe  that  the  small-pox  be¬ 
came  totally  extinct.  However,  in  spite  of  glaring  facts  of 
this  description,  I  must  candidly  acknowledge,  I  am  not  at  all 
surprised,  that  both  in  our  country  and  in  other  parts  of  the 
world,  a  partial  prejudice  should  now  and  then  lift  up  its  head. 
It  is  called  into  existence,  not  from  any  thing  faulty  in  the 
principle  of  Vaccination, but  from  a  wrong  and  injudicious  ap¬ 
plication  of  that  principle.  For  example,  a  child  or  a  family  of 
children,  may  be  in  such  a  state,  that  the  action  of  the  vaccine 
fluid  when  applied  to  the  skin,  shall  be  either  wholly  or  par¬ 
tially  resisted.  It  may  either  produce  no  effect  at  all,  or  it  may 
produce  pustules,  varying  considerably  in  their  rise,  progress, 
and  general  appearances,  from  those  which  have  been  desig¬ 
nated  by  the  term  correct.  It  was  about  the  year  1804,  that  I 
was  fortunate  enough  to  discover  the  general  cause  of  these 
deviations,  and  no  sooner  was  it  fully  impressed  on  my  mind, 
than  I  published  it  to  the  world.  Though  all  may  have  access 
to  the  paper*  with  the  greatest  facility,  yet  few,  very  few  in¬ 
deed,  among  those  who  vaccinate,  have  paid  any  attention  to 
it;  yet  I  am  confident,  from  a  review  of  the  practice  on  an  im- 

*  See  Appendix,  No.  III. 


5 


mense  scale,  and  through  a  period  of  more  than  twenty  years, 
that  it  is  a  matter  which  has  a  greater  claim  on  our  attention, 
than  any  one  thing  besides  connected  with  Vaccination — in¬ 
deed  I  may  say  than  every  other  thing.  What  I  allude  to  is  a 
coincident  eruptive  state  of  the  skin,  principally  bearing  what 
we  call  the  herpetic  or  irritative  character.  If  we  vaccinate  a 
child  under  its  influence,  we  are  apt  to  create  confusion.  The 
pustule  will  participate  in  the  character  of  the  herpetic  blotch, 
and  the  two  thus  become  blended,  forming  an  appearance  that 
is  neither  vaccine  nor  herpetic;  but  the  worst  of  it  is,  that  the 
patient  does  not  receive  that  perfect  security  from  small-pox 
infection,  which  is  given  b  the  perfect  pustules.  It  by  no 
means  always  happens  that  the  appearance  of  an  eruption  of 
this,  or  any  other  description,  prevents  security;  but  it  is  so 
commonly  the  case,  that  I  cannot  too  much  enforce  the  neces¬ 
sity  for  rigid  attention  in  the  inoculator,  whenever  a  child  is 
presented  to  him  for  vaccination,  under  such  circumstances. 
If  the  case  admits  of  no  delay,  these  irritative  affections  of  the 
skin  should  be  removed  at  once;  which  may  be  done  with  ease, 
and  the  most  perfect  safety,  when  they  are  not  very  numerous 
and  of  long  standing;  medicine  in  that  case  may  be  necessary 
in  conjunction  with  an  application.  Bat  on  this  subject  I  need 
not  enlarge,  as  it  is  more  particularly  spoken  of  in  the  paper 
referred  to.  However,  I  may  now  just  say,  that  the  applica¬ 
tion  I  make  use  of  for  destroying  these  eruptions,  is  the  un- 
guentum  h  drargyri  nitrati  of  the  last  London  Dispensatory. 

One  word  more  with  respect  to  prejudice.  How  frequently 
have  we  seen,  in  a  variety  of  the  public  prints,  paragraphs  of 
this  description — u  A  gentleman’s  family,  consisting  of  three 
or  four  or  half  a  dozen  children,  were  vaccinated  by  an  emi¬ 
nent  surgeon,  and  all  went  through  the  disease  in  the  most 
satisfactory  manner,  and  were  pronounced  safe;  yet,  on  being 
exposed  to  the  infection  of  the  small-pox,  they  all  had  the 
disease,  but  happily  they  all  recovered.”  Here,  sir,  the  mind 
becomes  entangled  with  a  false  association.  The  public  con¬ 
ceive,  that  an  eminent  surgeon  must  be  a  perfect  master  of  this 
little  branch  of  our  art;  but  it  often  happens  that  he  has  not 
stooped  to  look  at  any  thing  beyond  its  outline;  and  when  de¬ 
viations  arise  in  the  progress  of  the  pustules,  to  that  extent 
which  I  have  pointed  out  as  momentous,  they  pass  by  without 
attracting  any  particular  attention. 

Pray  excuse  me — I  find  myself  spinning  out  my  letter  into 
an  essay’,  and  at  last  was  like  to  have  forgotten  the  most  im¬ 
portant  part  of  your  inquiry;  namely,  “  whether  I  myself  hadr 


6 


not  renounced  my  opinion  of  the  efficacy  of  Vaccination.” 
This  question  has  been  often  put  to  me — why?  I  cannot  con¬ 
ceive.  It  came  not  long  since,  through  a  medical  friend  of 
mine  in  London,  from  a  very  respectable  lady  in  the  country, 
whose  children  had  been  vaccinated.  I  know  not  how  to  give 
you  more  complete  satisfaction  on  this  point,  than  by  a  quota¬ 
tion  from  the  letter  written  to  my  medical  friend  in  reply. 

“  The  ghost  that  has  appeared  to  Mrs.  C.  has  taken  an 
annual  stalk  over  the  country  for  these  ten  years  past.  I  find 
no  great  difficulty  in  laying  it;  but  I  cannot  give  it  final  repose; 
the  phantom  will  rise  again  in  spite  of  me.  If  you  will  look 
over  your  records  relating  to  Vaccination  in  Ireland,  you  will 
find,  by  one  of  the  annual  reports  distributed  by  Dr.  Labatt, 
that  this  spirit  appeared  in  Dublin  not  many  years  since,  and 
made  many  furious  menaces,  disturbing  the  tranquillity  of 
some  of  the  inhabitants  of  that  fair  city.  There  you  will  see  a 
letter  of  mine  written  to  the  doctor,  so  much  in  point  with 
regard  to  Mrs.  C.’s  enquiry,  that  really  I  cannot  add  any  thing 
to  it,  as  my  opinion  of  the  powers  of  Vaccination  is  precisely 
the  same  now  as  it  was  then.  Indeed,  if  it  had  wanted  strength 
at  that  time,  it  has  since  obtained  it  most  abundantly.  I  beg 
then  that  you  will  let  Mrs.  C.  know,  my  confidence  in  the  effi¬ 
cacy  of  the  Vaccine ,  to  guard  the  constitution  from  the  small¬ 
pox ,  is  not  in  the  least  diminished.  That  exceptions  to  the 
general  rule  have  appeared,  and  that  they  will  sometimes  ap¬ 
pear,  I  am  ready  to  admit.  They  have  happened  after  small¬ 
pox  inoculation;  and  by  the  same  rule,  as  the  two  diseases  are 
so  similar,  should  they  not  happen  after  the  Vaccine  ?” 

Believe  me,  dear  sir,  with  great  respect, 

Your  obt.  and  faithful  servant, 

EDW.  JENNER. 


Berkeley,  Glostersfiire, 
19th  August,  1818.  3 


APPENDIX. 


No.  I. 

Copy  of  a  Letter  from  the  President  of  the  National  Vaccine 

Establishment ,  to  Lord  Sidmouth,  dated  15th  July,  1814; 

enclosing,  Report  on  the  State  of  Vaccination  in  Sweden. 

N.  V.  E.  Leicester  Square,  15th  July,  1814. 

My  Lord, 

The  Board  of  the  National  Vaccine  Establishment  have 
received  the  enclosed  Report,  “  On  the  state  of  Vaccination 
in  Sweden,”  since  they  had  the  honour  of  communicating  to 
your  Lordship  their  Report  of  the  State  of  Vaccination,  du¬ 
ring  the  Year  1813,  and  they  respectfully  desire  that  it  may  be 
submitted  to  the  Honourable  the  House  of  Commons,  in  or¬ 
der  that  it  may  be  printed,  and  subjoined  as  an  Appendix  to 
their  Report. 

(Signed)  J.  LATHAM,  President. 

Jas.  Hervey,  M.  D. 

Registrar. 

To  the  Right  Honourable  Lord  Viscount  Sidmouth, 

&c.  &c.  &c. 

REPORT  OF  THE  STATE  OF  VACCINATION  IN  SWEDEN. 

(Translated  from  the  original  in  Swedish.) 

On  the  fourteenth  of  January,  1814,  Mr.  Macmichael,  an 
English  Gentleman,  attended  the  Royal  College  of  Health,  in 
Stockholm,  and  delivered  to  the  College  a  copy  of  the  Report 
of  the  National  Vaccine  Establishment  in  London, 
dated  22d  of  April,  1813,  and  presented  to  Lord  Sidmouth, 
Secretary  of  State  for  the  Home  Department;  at  the  same 
time  he  requested  that  a  short  Account  of  the  progress  of 
Vaccination  in  Sweden,  and  of  the  measures  which  had  been 
adopted  for  its  promotion,  might  be  communicated  to  him,  for 
the  information  of  the  British  Parliament. 

The  Royal  College  had  particular  satisfaction  in  receiving 
Mr.  Macmichael,  and  undertook  to  comply  with  his  request, 
so  much  the  more  readily,  as  it  had  the  pleasure  of  numbering 
among  its  honorary  Members  the  respectable  name  of  Dr. 
Jenner,  for  whom  it  was  reserved  to  demonstrate,  by  the  most 
decisive  experiments,  the  protective  power  of  the  Cow-Pox 
against  the  most  terrible  and  destructive  contagion  of  the 
Small-Pox;  a  pestilence,  which  by  means  of  this  blessed  dis¬ 
covery,  must  certainly  be  ultimately  extirpated  from  the  face 
of  the  earth. 


8 


It  was  to  be  expected,  from  the  excellent  arrangements 
which  the  Kings  of  Sweden  had  adopted  for  somevvhat  more 
than  half  a  century,  in  every  department  of  Medical  Science, 
that  the  incomparable  discovery  o(  Doctor  Jenner,  like  the  In¬ 
oculation  for  the  Small  Pox  at  a  former  period,*  should  not 
only  become  an  object  of  the  most  accurate  investigation,  but 
also,  when  approved  by  experience,  be  generally  introduced 
and  promoted  by  rewards  and  established  regulations. 

The  Medical  Practitioners  of  Sweden,  who  had  already 
been  informed,  from  the  time  of  Dr.  Jenner’s  first  discovery, 
by  means  of  a  constant  correspondence  with  the  learned  in 
other  countries,  of  the  expectations  which  were  entertained  of 
the  success  of  experiments  made  with  the  Cow  Pox,  had  great 
pleasure  in  learning  that  one  of  their  colleagues,  Dr.  Gahn,  a 
Member  of  the  Royal  College,  had,  towards  the  end  of  1799, 
procured  some  Vaccine  Matter,  and  obtained  the  most  satis¬ 
factory  result  from  inoculating  with  it.  Another  Swedish 
Physician,  now  Professor  of  Medicine,  Dr.  Rosenskold,  print¬ 
ed,  in  1801,  a  small  pamphlet,  entitled,  “  To  the  Public  oq 
the  Cow-Pox;”  and  performed  Vaccination  with  success, 
in  several  parishes  in  Skane.  About  the  same  time  the  un¬ 
dersigned  also  published  a  more  detailed  account,  with  colour¬ 
ed  figures,  under  the  title,  u  The  Small-Pox  may  be  extirpa¬ 
ted;”  and  this  Essay  was  distributed  to  all  the  Churches  in 
the  Kingdom. 

The  Government,  already  attentive  to  the  inestimable  ad¬ 
vantage,  which  the  Inoculation  of  the  Cow-Pox  seemed  to 
promise,  directed  the  College  to  examine  Dr.  Jenner’s  disco¬ 
very  with  the  greatest  accuracy;  for  which  the  proper  means 
were  immediately  afforded  :  and  the  College  was  ordered, 
after  collecting  the  results,  to  present  its  Report  to  the  King. 

This  Report,  which  fully  confirmed  the  excellence  of  the 
Jennerian  discovery,  occasioned  the  salutary  law,  which  was 
first  enacted  in  1803,  by  which  Vaccination  was  established 
throughout  the  Kingdom;  and  the  College  was  commanded 
to  promote  its  adoption  by  all  possible  means.  The  King  was 
pleased  to  appropriate  900  dollars,  spec,  banco,  to  be  divided 
into  Premiums,  which  were  to  be  distributed  among  such  Me- 

*  It  is  remarkable,  that  the  celebrated  Dr.  David  Schultzenheim,  who 
was  appointed  as  long- ago  as  1754,  by  the  States  of  the  Kingdom,  to  inquire 
into  Sutton  and  Dimsdale’s  Mode  of  Inoculating  the  Small  Pox  in  England, 

now  the  President  of  the  Royal  College  of  Health,  and  has  been  the  most 
instrumental,  by  means  of  his  powerful  influence,  in  promoting  the  most  sa, 
lutary  measure,  for  the  introduction  of  Vaccination. 


4 


9 


dical  men  as  could  exhibit  the  greatest  number  of  vaccinated 
persons. 

A  particular  regulation  was  made  for  the  Metropolis,  im¬ 
posing  a  fine  of  Three  Dollars  on  any  one,  who  should  fail  to 
announce  to  the  Medical  Officer  of  the  district,  the  appearance 
of  the  contagion  of  the  Small  Pox :  and  in  every  such  case, 
the  person  infected  was  to  be  carried  to  the  Small-Pox  Hos¬ 
pital:  where  every  measure  was  adopted  for  his  being  proper¬ 
ly  nursed;  and  the  same  precautions  have  been  continued  to 
the  present  time. 

It  was  long  a  question,  Whether  new-born  Children  could 
be  vaccinated  with  success,  and  whether  the  Matter  taken 
from  them  might  be  employed  with  as  much  security  as  if 
taken  from  Adults? 

This  doubt  has  been  altogether  removed;  and  in  the  Gene¬ 
ral  Lying- io-Hospital  all  the  children  are  now  vaccinated 
within  nine  days  from  the  time  of  their  birth:  so  that,  by 
means  of  this  progressive  Vaccination,  fresh  matter  remains 
constantly  in  existence. 

The  want  of  a  sufficient  supply  of  Vaccine  Matter  for  the 
extensive  provinces  of  the  Kingdom,  was  long  an  obstacle  to 
the  universality  of  Vaccination  in  Sweden.  This  obstacle  no 
longer  exists:  since  the  Royal  College  of  Health,  in  conse¬ 
quence  of  the  humble  representations  which  it  made  to  the 
King,  obtained  the  adoption  of  a  very  effectual  measure  for 
this  purpose,  in  the  appointment  of  a  particular  Establishment 
for  the  general  regulation  of  Vaccination  throughout  the  King¬ 
dom,  which  took  place  in  the  year  1812. 

This  Establishment  consists  of  a  Director,  and  several  in¬ 
spectors  of  the  Stations  for  Vaccination  in  the  Provinces.  The 
Director  is  a  Member  of  the  Royal  College  of  Health,  whom 
the  King  has  graciously  commanded  to  receive  and  examine 
all  reports,  to  answer  all  enquiries,  to  conduct  the  distribution 
of  Vaccine  Matter,  which  is  delivered,  free  of  postage,  to  all 
persons  who  apply  for  it;  and  lastly,  to  report  to  the  College 
every  thing  relating  to  Vaccination  that  requires  further  regu¬ 
lation,  and  to  propose  to  it,  as  proper  persons  to  receive  rewards, 
all  those  who  appear  to  be  the  most  deserving.  He  has  also 
the  immediate  inspection  of  all  the  Medical  men,  who  are  ap¬ 
pointed  to  conduct  the  business  of  the  Stations,  established  in  ' 
almost  every  Province;  the  progressive  Vaccination  perform¬ 
ed  at  these  Stations  being  calculated  to  maintain  a  constant 
supply  of  fresh  Matter,  which  is  also  distributed,  free  of  post¬ 
age,  to  those  who  require  it;  and  their  proceedings  being  re¬ 
gistered  in  proper  Catalogues  and  Journals. 

B 


10 


In  Stockholm,  three  several  Stations  of  this  kind  have  been 
appointed,  whence  fresh  Matter  may  always  be  procured  with 
certainty,  if  it  happen  to  be  wanting  in  any  particular  Pro¬ 
vince. 

The  Archbishops,  Bishops,  and  the  whole  of  the  Clergy 
throughout  the  kingdom,  having,  from  the  time  of  the  happy  dis¬ 
covery  of  Vaccination,  embraced  it  with  the  most  distinguished 
zeal;  and  many  of  this  respectable  body  having  not  only  em¬ 
ployed  the  most  effectual  means  for  the  removal  of  vulgar  preju¬ 
dice  against  it,  but  having  even  actually  practised  Vaccination 
themselves;  the  King,  assured  of  the  continued  exertions  of 
the  Clergy  in  the  same  cause,  was  pleased  to  direct,  that  every 
Minister  should  superintend  the  progress  of  Vaccination  with¬ 
in  his  parish:  and  should  be  empowered  to  call  to  his  assist¬ 
ance  one  or  more  Inspectors  of  Vaccination,  according  to 
circumstances,  for  the  purpose  of  causing  all  Children  t<*  be 
properly  vaccinated  within  the  first  year  after  their  birth,  and 
keeping  proper  documents  of  the  performance  of  the  operation. 
In  each  Parish  or  District,  there  must  be  an  accredited  Vacci¬ 
nator,  whose  duty  is  to  perform  Vaccination,  and  to  give  a  Re¬ 
port  of  his  proceedings  to  the  Royal  College  of  Health. 

The  College  has  also  published,  by  the  King’s  command,  a 
Book  of  Instructions  for  Vaccinators  and  Inspectors  of  Vac¬ 
cination,  which  has  been  distributed  gratis  to  all  the  Churches 
in  the  Kingdom.  This  Treatise,  adapted  to  the  use  of  the 
Public,  affords  an  accurate  knowledge  of  the  true  and  false 
Cow-Pox;  of  the  varieties  which  most  frequently  occur  in  it; 
and  of  the  cutaneous  diseases,  which  occur  so  often  in  Swe¬ 
den,  very  nearly  resembling  the  Small-Pox. 

For  the  more  effectual  encouragement  of  the  practice  of 
Vaccination,  the  King  has  been  graciously  pleased  to  appoint 
rewards  of  two  different  kinds,  Pecuniary  Premiums,  and  Ho¬ 
norary  Medals.  The  latter  are  distributed,  commonly  in  Sil¬ 
ver,  but  sometimes  iu  Gold,  to  those  who  have  particularly 
distinguished  themselves.  In  all  cases,  those  who  have  deserv¬ 
ed  rewards,  are  humbly  pointed  out  to  the  King,  by  the  Col¬ 
lege  ol  Health;  and  his  Majesty  has  reserved  to  himself  the 
right  of  assigning  the  proportions  in  which  those  rewards  shall 
be  distributed.  It  is  also  in  the  King’s  name,  and  with  a  cer¬ 
tain  degree  of  publicity,  that  these  marks  of  his  approbation 
are  bestowed. 

For  the  honour  of  the  Medical  Profession  in  Sweden,  it 
must  not  be  forgotten,  that  although  Inoculation  for  the  Small- 
Pox  was  one  of  the  most  lucrative  branches  of  their  pri- 


11 


vate  practice,  and  has  been  entirely  superseded  by  the  sim¬ 
ple  process  of  Vaccination,  no  one  individual  of  the  profes¬ 
sion  has  raised  any  obstacles  against  the  Cow-Pox;  but  every 
one  has  contributed  to  its  advancement,  by  giving  advice,  in¬ 
formation,  and  assistance,  to  the  utmost  of  his  ability.  No 
single  publication  has  appeared  to  call  in  question  its  high  im¬ 
portance,*  and  its  superiority  to  Variolous  Inoculation;  which 
has  been  entirely  discontinued  ever  since  the  year  1802,  rather 
by  a  tacit  and  universal  consent,  than  in  consequence  of  any 
Royal  prohibition. 

It  may  therefore  be  asserted,  that  the  Small- Pox,  that  equal¬ 
ly  disgusting  and  destructive  pestilence,  which  for  many  ages 
continued  annually  to  send  out  of  the  world  an  immense  num¬ 
ber  of  young  Children,  is  now,  through  the  influence  of  Dr. 
Jenner’s  inestimable  discovery,  so  perfectly  extirpated  in  Swe¬ 
den,  that  it  never  can  become  epidemic,  even  if  at  any  time, 
notwithstanding  all  the  orders  and  all  the  vigilance  employed 
for  its  exclusion,  the  infection  should  make  its  appearance. 
Such,  in  the  last  twelve  years,  has  been  the  effect  of  the  King’s 
wise  and  humane  attention,  of  the  unanimity  and  disinterested¬ 
ness  of  the  Medical  Profession,  of  the  patriotic  zeal  of  the 
Clergy,  of  the  good  examples  so  promptly  exhibited  by  the 
upper  classes,  and  of  the  progress  of  information  and  civiliza¬ 
tion  in  the  lower. 

The  undersigned,  who  has  drawn  up  this  short  account,  at 
the  request  of  the  Royal  College  of  Health,  has  also  the  ho¬ 
nour  of  sending  with  it,  in  the  name  of  the  college,  a  Copy  of 
the  Book  of  Instructions,  and  an  impression  in  Silver  of  the 
Honorary  Medal,  which  was  struck  by  the  King’s  command, 
under  the  direction  of  the  College,  and  which  is  distributed  in 
the  King’s  name  for  the  promotion  of  Vaccination. 

FR.  HEDIN,  M.  D. 

First  Physician  to  the  King,  Medical  Counsellor, 
&c.  &c. 

Stockholm,  10th  February,  1814. 

*  The  answer  which  the  undersigned  returned  the  1st  November,  1801, 
to  a  Letter  addressed  to  him,  by  the  Vaccine  Committee  of  the  Society  of 
Medicine,  at  Paris,  and  which  is  inserted  in  the  second  Report  of  that  Com¬ 
mittee,  cannot  justly  be  considered  as  a  Publication  of  this  kind.  It  was 
not  quite  three  Months  after  this  time,  that,  having  acquired  perfect  confi¬ 
dence  from  inoculating  a  Cow,  with  the  Cow-Pox,  and  transferring  the  ope¬ 
ration  to  the  human  subject,  be  published  the  before-mentioned  Essay,  en¬ 
titled,  “  The  Small-Pox  may  be  extirpated.” 


No.  II. 


Supplement  to  the  Madrid  Gazette ,  of  the  14 th  October ,  1806.* 

On  Sunday,  the  7th  of  September  last,  Dr.  Francis  Xavier 
Balmis,  Surgeon  Extraordinary  to  the  King,  had  the  honour 
of  kissing  his  Majesty’s  hand,  on  occasion  of  his  return  from 
a  voyage  round  the  world,  executed  with  the  sole  object  of 
carrying  to  all  the  possessions  of  the  Crown  of  Spain,  situated 
beyond  the  seas,  and  to  those  of  several  other  nations,  the  in¬ 
estimable  gift  of  Vaccine  Inoculation.  His  Majesty  has  inquir¬ 
ed,  with  the  liveliest  interest,  in  all  that  materially  related  to 
the  expedition,  and  learned  with  the  utmost  satisfaction,  that 
its  result  has  exceeded  the  most  sanguine  expectations  that 
were  entertained  at  the  time  of  the  enterprize. 

This  undertaking  had  been  committed  to  the  diligence  of 
several  Members  of  the  Faculty,  and  subordinate  persons, 
carrying  with  them  twenty-two  children,  who  had  never  under¬ 
gone  the  Small  Pox,  selected  for  the  preservation  of  the  pre¬ 
cious  fluid,  by  transmitting  it  successively  from  one  to  another, 
during  the  course  of  the  voyage.  The  expedition  set  sail  from 
Corunna,  under  the  direction  of  Balmis,  on  the  30th  of  Novem¬ 
ber,  1803.  It  made  the  first  stoppage  at  the  Canary  Islands, 
the  second  at  Porto  Rico,  and  the  third  at  the  Caracas.  On 
leaving  that  Province,  by  the  port  of  La  Guayra,  it  was  divided 
into  two  branches:  one  part  sailing  to  South  America,  under 
the  charge  of  the  Subdirector  Don  Francis  Salvani;  the  other, 
with  the  Director  Balmis  on  board,  steering  for  the  Havanah, 
and  thence  for  Yucatan.  There  a  subdivision  took  place:  the 
Professor  Francis  Pastor  proceeding  from  the  port  of  Sisal,  to 
that  of  villa  Hermosa,  in  the  province  of  Tobasca,  for  the  pur¬ 
pose  of  propagating  Vaccination  in  the  district  of  Ciudad 
Real  of  Chiapa,  and  on  to  Goatemala,  making  a  circuit  of  four 
hundred  leagues,  through  a  long  and  rough  road,  comprising 
Oaxaca;  while  the  rest  of  the  expedition,  which  arrived  with¬ 
out  accident  at  Vera  Cruz,  traversed  not  only  the  Vice-royal¬ 
ty  of  New  Spain,  but  also  the  interior  provinces;  whence  it  was 
to  return  to  Mexico,  which  was  the  point  of  re-union. 


*  This  shows  with  what  ardor  the  Spaniards  disseminated  Vaccination. 
It  subsequently  appeared,  by  documents  received  from  various  parts  of  South 
.America,  that  this  embassy  had  been  the  means  of  subduing  the  Small-pox 
in  most  of  the  Provinces  belonging  to  the  King  of  Spain  on  that  continent. 

Doctor  Jenner. 


13 


This  precious  preservative  against  the  ravages  of  the  Small 
Pox  has  already  been  extended  through  the  whole  of  North 
America,  to  the  coasts  of  Sonora  and  Sinaloa,  and  even  to  the 
Gentiles  and  Neophites  of  High  Pimeria.  In  each  capital  a 
Council  has  been  instituted,  composed  of  the  Principal  Au¬ 
thorities,  and  the  most  zealous  members  of  the  Faculty,  charg¬ 
ed  with  the  preservation  of  this  invaluable  specific,  as  a  sa¬ 
cred  deposit,  for  which  they  are  accountable  to  the  King  and 
to  posterity. 

This  being  accomplished,  it  was  the  next  care  of  the  Direc¬ 
tor  to  carry  this  part  of  the  expedition  from  Africa  to  Asia, 
crowned  with  the  most  brilliant  success,  and,  with  it,  the  com¬ 
fort  of  Humanity.  Some  difficulties  having  been  surmounted, 
he  embarked  in  the  port  of  Acapulco  for  the  Philippine  Isl¬ 
ands;  that  being  the  point  at  which,  if  attainable,  it  was  origi¬ 
nally  intended  that  the  undertaking  should  be  terminated. 

The  bounty  of  Divine  Providence  having  vouchsafed  to  se¬ 
cond  the  great  and  pious  designs  of  the  King,  Balmis  happily 
performed  the  vpyage  in  little  more  than  two  months:  carry¬ 
ing  with  him,  from  New  Spain,  twenty-six  children,  destined 
to  be  vaccinated  in  succession,  as  before;  and  as  many  of  them 
were  infants,  they  were  committed  to  the  care  of  the  Matron 
of  the  Foundling  Hospital  at  La  Corunna,  who,  in  this,  as 
well  as  the  former  voyages,  conducted  herself  in  a  manner  to 
merit  approbation.  The  expedition  having  arrived  at  the  Phil¬ 
ippines,  and  propagated  the  specific  in  the  islands  subject  to 
his  Catholic  Majesty,  Balmis,  having  concluded  his  philan¬ 
thropic  commission,  concerted  with  the  Captain  General  the 
means  of  extending  the  beneficence  of  the  King,  and  the  glory 
of  his  august  name,  to  the  remotest  confines  of  Asia. 

In  point  of  fact,  the  Cow-pox  has  been  disseminated  through 
the  vast  Archipelago  of  the  Visayan  Islands,  whose  Chiefs, 
accustomed  to  wage  perpetual  war  with  us,  have  laid  down 
their  arms,  admiring  the  generosity  of  an  enemy,  who  confer¬ 
red  upon  them  the  blessings  of  health  and  life,  at  the  time 
when  they  were  labouring  under  the  ravages  of  an  epidemic 
Small- Pox.  The  principal  persons  of  the  Portuguese  colonies, 
and  of  the  Chinese  empire,  manifested  themselves  no  less  be¬ 
holden,  when  Balmis  reached  Macao  and  Canton;  in  both 
which  places  he  accomplished  the  introduction  of  fresh  virus, 
in  all  its  activity,  by  the  means  already  related:  a  result,  which 
the  English  on  repeated  trials,  had  failed  to  procure,  in  the 
various  occasions  when  they  brought  out  portions  of  matter 


14 


in  the  ships  of  their  East  India  Company,  which  lost  their  effi¬ 
cacy  on  the  passage,  and  arrived  inert. 

After  having  propagated  the  Vaccine  at  Canton,  as  far  as 
possibility  and  the  political  circumstances  of  the  empire  would 
permit,  and  having  confided  the  further  dissemination  of  it  to 
the  Physicians  of  the  English  factory  at  the  above-mentioned 
port,  Balmis  returned  to  Macao,  and  embarked  in  a  Portu¬ 
guese  vessel  for  Lisbon;  where  he  arrived  on  the  15th  Au¬ 
gust.  In  the  way  he  stopped  at  St.  Helena,  in  which,  as  in 
other  places,  by  dint  of  exhortation  and  perseverance,  he  pre¬ 
vailed  upon  the  English  to  adopt  the  astonishing  antidote, 
which  they  had  undervalued  for  the  space  of  more  than 
eight  years,  though  it  was  a  discovery  of  their  nation,  and 
though  it  was  sent  to  them  by  Jenner  himself. 

Of  that  branch  of  the  expedition  which  was  destined  for 
Peru,  it  is  ascertained  that  it  was  shipwrecked  in  one  of  the 
mouths  of  the  River  de  la  Magdalena;  hut  having  derived  im¬ 
mediate  succour  from  the  natives,  from  the  Magistrates  adja¬ 
cent,  and  from  the  Governor  of  Carthagena,  the  Subdirector, 
the  three  Members  of  the  Faculty  who  accompanied  him,  and 
the  children,  were  saved,  with  the  fluid  in  good  preservation, 
which  they  extended  in  that  port,  and  its  province,  with  acti¬ 
vity  and  success.  Thence  it  was  carried  to  the  isthmus  of  Pa¬ 
nama,  and  persons  properly  provided  with  all  necessaries,  un¬ 
dertook  the  long  and  painful  navigation  of  the  River  de  la 
Magdalena:  separating,  when  they  reached  the  interior,  to 
discharge  their  commission  in  the  towns  of  Teneriffe,  Mom- 
pox,  Ocana,  Socorro,  San  Gil  y  Medellin,  in  the  valley  of  Cu- 
cuta,  and  in  the  cities  of  Pamplona,  Giron,  Tunja,  Velez,  and 
other  places  in  the  neighbourhood,  until  they  met  at  Santa  Fe: 
leaving  every  where  suitable  instructions  for  the  Members  of 
the  Faculty,  and  in  the  more  considerable  towns,  regulations 
conformable  to  those  rules  which  the  Director  had  prescribed 
for  the  preservation  of  the  virus;  which  the  Viceroy  affirms  to 
have  been  communicated  to  fifty  thousand  persons  without 
one  unfavourable  result.  Towards  the  close  of  March,  1805, 
they  prepared  to  continue  their  journey  in  separate  tracks,  for 
the  purpose  of  extending  themselves,  with  the  greater  facility 
and  promptitude,  over  the  remaining  districts  of  the  Vice¬ 
royalty,  situated  in  the  road  of  Popayan,  Cuenca,  and  Quito, 
as  far  as  Lima.  In  the  August  following  they  reached  Guaya¬ 
quil. 

The  result  of  this  expedition  has  been,  not  merely  to  spread 
the  Vaccine  among  all  people,  whether  friends  or  enemies; 


15 


among  Moors,  among  Visayans,  and  among  Chinese;  but  also 
to  secure  to  posterity,  in  the  dominions  of  his  Majesty,  the 
perpetuity  of  so  great  a  benefit;  partly  by  means  of  the  Central 
Committees  that  have  been  established,  as  well  as  by  the  dis¬ 
covery  which  Balmis  made  of  an  indigenous  matter  in  the  cows 
of  the  valley  of  Atlixco,  near  the  city  of  Puebla  de  los  Ange¬ 
les;  in  the  neighbourhood  of  that  of  Valladolid  de  Mechoa- 
can,  where  the  Adjutant  Antonio  Gutierrez  found  it;  and  in 
the  district  of  Calabozo,  in  the  province  of  Caracas,  where 
Don  Carlos  de  Pozo,  Physician  of  the  residence,  found  it. 

A  multitude  of  observations,  which  will  be  published  with¬ 
out  delay,  respecting  the  developement  of  the  Vaccine  in  va¬ 
rious  climes,  and  respecting  its  efficacy,  not  merely  in  prevent¬ 
ing  the  Natural  Small-Pox,  but  in  curing  simultaneously  other 
morbid  affections  of  the  human  frame,  will  manifest  hofr  im¬ 
portant  to  humanity  will  prove  the  consequences  of  an  expedi¬ 
tion,  which  has  no  parallel  in  history. 

Though  the  object  of  this  undertaking  was  limited  to  the 
communication  of  the  Vaccine  in  every  quarter;  to  the  instruc¬ 
tion  of  Professors,  and  to  the  establishment  of  regulations, 
which  might  serve  to  render  it  perpetual, — nevertheless,  the 
Director  has  omitted  no  means  of  rendering  his  services  bene¬ 
ficial,  at  the  same  time,  to  agriculture  and  the  Sciences.  He 
brings  with  him  a  considerable  collection  of  exotic  plants.  He 
has  caused  to  be  drawn  the  most  valuable  subjects  in  Natural 
History.  He  has  amassed  much  important  information;  and, 
among  other  claims  to  the  gratitude  of  his  country,  not  the 
least  consists  in  having  imported  a  valuable  assemblage  of 
trees  and  vegetables,  in  a  state  to  admit  of  propagation;  and 
which,  being  cultivated  in  those  parts  of  the  Peninsula  that 
are  most  congenial  to  their  growth,  will  render  this  expedition 
as  memorable  in  the  annals  of  Agriculture,  as  in  those  of  Me¬ 
dicine  and  Humanity.  It  is  hoped  that  the  Subdirector  and 
his  coadjutors,  appointed  to  carry  these  blessings  to  Peru,  will 
shortly  return  by  way  of  Buenos- Ayres,  after  having  accom¬ 
plished  their  journey  through  that  Vice-royalty,  the  Vice-roy¬ 
alty  of  Lima,  and  the  districts  of  Chili  and  Charcas;  and  that 
they  will  bring  with  them  such  collections  and  observations  as 
they  have  been  able  to  acquire,  according  to  the  instructions 
given  by  the  Director,  without  losing  sight  of  the  philanthro¬ 
pic  commission  which  they  received  from  his  Majesty  in  the 
plenitude  of  his  zeal  for  the  welfare  of  the  human  race. 


No.  III. 


To  the  Editors  of  the  Medical  and  Physical  Journal. 

Gentlemen, 

Those  herpetic  affections  which  so  frequently  appear 
among  the  children  of  the  poor,  and  which  are  evidently 
contagious,  often  prevent  the  vaccine  virus  from  producing 
its  correct  action.  The  skin,  although  it  be  apparently  sound 
at  the  point  of  insertion,  is  nevertheless  so  influenced  by  the 
disease,  as  frequently  to  baffle  all  our  efforts  to  produce  a  cor¬ 
rect  pustule,  and  consequently  to  secure  the  constitution  from 
the  contagion  of  the  small-pox.  The  eruptions  I  allude  to, 
for  the  most  part,  correspond  with  those  of  the  Second  Order 
of  Cutaneous  Diseases  described  by  the  ingenious  Dr.  Wil- 
lan,  under  the  term  Psoriasis  Diffusa .*  The  face,  the  eye¬ 
lids,  the  tender  skin  behind  the  ears,  and  particularly  the  scalp, 
are  the  parts  most  commonly  affected ;  but  the  limbs  and  body 
not  unfrequently  exhibit  the  same  appearances.  As  far  as  I 
have  been  able  to  observe,  it  is  more  common  among  the  lower 
classes  of  society  in  the  country  than  in  London.  It  is  not 
uncommon  to  see  it  pass  through  a  village  school,  assuming  a 
variety  of  characters,  according  to  the  state  of  the  constitution 
of  the  child  affected  with  it.  I  do  not  mean  to  say,  that  the 
pustulef  is  always  imperfect,  and  not  effective,  when  the  ino¬ 
culated  patient  has  this  malady;  on  the  contrary,  it  is  some¬ 
times  perfectly  correct,  and  much  more  frequently  so  when  it 
has  been  of  long  standing,  than  when  in  its  recent  state;  and 
what  is  remarkable,  the  disease  is  then  (when  of  long  duration) 
sometimes  swept  entirely  away.  I  have  noticed  this  impedi¬ 
ment  to  the  perfect  formation  and  progress  of  the  vaccine  pus¬ 
tule,  in  my  general  correspondence,  for  more  than  two  years 
past,  and  conceive  it  to  be  a  more  frequent  source  of  the  spu¬ 
rious  pustule  than  any  other,  or  indeed  than  all  the  rest  united. 
Dr.  Marcet  inserted  some  hints  I  communicated  to  him  on 
this  head,  in  your  Journal,  for  May,  1803,  but  I  believe  they 
have  not  been  much  attended  to. 

In  my  Paper  of  Instructions  for  Vaccine  Inoculation,  pub- 

*  The  labours  of  Dr.  Willan  in  this  rugged  field  of  science,  all  should  ac¬ 
knowledge  with  thankfulness  and  gratitude. 

f  Having  in  my  former  Treatises  used  the  term  pustule ,  I  make  choice  of  it 
now,  lest  it  should  create  confusion;  though,  perhaps,  not  so  appropriate  as 

tiock  or  vesicle. 


17 


Mshed  some  years  back,  I  have  endeavoured  to  guard  the 
inoculator  from  being  deceived  by  false  appearances,  by  the 
following  observations. 

“  The  vaccine  fluid  is  liable,  from  causes  apparently  trifling, 
to  undergo  a  decomposition.  In  this  state  it.  sometimes  pro¬ 
duces  what  has  been  denominated  the  spurious  pustule;  that  is, 
a  pustule, or  an  appearance  on  the  arm  not  possessing  the  charac¬ 
teristic  marks  of  the  genuine  pustule.  Anomalies  assuming  dif¬ 
ferent  forms  may  be  excited,  according  to  the  qualities  of  the 
virus  applied,  or  the  state  of  the  person  inoculated;  but  bv  far 
the  most  frequent  variety  or  deviation  from  the  perfect  pus¬ 
tule,  is  that  which  arrives  at  maturity  and  finishes  its  progress, 
much  within  the  time  limited  by  the  true.  Its  commencement 
is  marked  by  a  troublesome  itching;  and  it  throws  out  a  pre¬ 
mature  efflorescence,  sometimes  extensive,  but  seldom  circum¬ 
scribed,  or  of  so  vivid  a  tint  as  that  which  surrounds  the  pus¬ 
tule  completely  organized;  and  (which  is  more  characteristic 
of  its  degeneracy  than  the  other  symptoms)  it  appears  more 
like  a  common  festering  produced  by  a  thorn  or  any  other 
small  extraneous  body  sticking  in  the  skin,  than  a  pustule  ex¬ 
cited  by  the  vaccine  virus.  It  is  generally  of  a  straw  colour, 
and  when  punctured,  instead  of  the  colourless,  transparent 
fluid  of  the  perfect  pustule,  its  contents  are  found  to  be  opaque. 
A  little  practice  in  vaccine  inoculation,  attentively  conducted, 
impresses  on  the  mind  the  perfect  character  of  the  vaccine 
pustule;  therefore,  when  a  deviation  arises,,  of  whatever  kind 
it  may  be,  common  prudence  points  out  the  necessity  of  re¬ 
inoculation.”  The  deviation,  when  it  arises  from  the  cuticular 
disease  I  am  speaking  of,  generally  corresponds  with  that 
above  recited.  I  might  have  added,  that  if  the  pustule  is  not 
much  disturbed  in  its  course  by  scratching,  it  commonly  ter¬ 
minates  in  a  scab  of  a  pale  brown  or  amber  colour,  and  soft  in 
its  texture,  compared  with  that  produced  by  the  true  vaccine 
pustule.  I  have  abundant  testimony  to  prove,  that  the  fluid 
taken  from  a  spurious  vaccine  pustule  thus  excited,  is  capable 
of  propagating  and  perpetuating  its  like.  Indeed,  the  vaccine 
fluid,  even  in  a  pustule  going  through  its  course  perfectly,  if 
taken  in  its  far  advanced  stages,  is  capable  of  producing  va¬ 
rieties,  which  will  be  permanent  if  we  continue  to  vaccinate 
from  it.  I  mention  the  subject  briefly  now;  but  it  is  my  inten¬ 
tion  (as  it  embraces  a  wide  field)  to  enlarge  upon  it,  and  some 
others  connected  with  vaccination,  when  circumstances  will 
permit  me.  Medical  practitioners  should  be  particularly  cir¬ 
cumspect  when  they  inoculate  those  who  have  cuticular  dis- 

C 


18 


eases.  The  danger  of  insecurity  would  be  at  once  obviated,  if 
on  the  appearance  of  an  irregular  pustule,  the  disease  wer  to 
be  subdued  by  proper  applications,  and  the  patient  then  re-ino¬ 
culated.  I  shall  select  a  case,  to  show  the  efficacy  of  this  mode 
of  proceeding. 

A  family,  consisting  of  five  fine  healthv-looking  children, 
were  inoculated  by  me  at  Cheltenham  in  the  autumn  of  1803 
with  fluid  virus  taken  immediately  from  a  proper  vaccine  pus¬ 
tule.  On  examining  the  punctures  on  the  fifth  day,  I  found, 
that  on  the  left  arm  of  one  of  the  children,  the  pustule  was  ad¬ 
vancing  too  rapidly.  It  was  of  an  irregular  form,  contained  al¬ 
ready  an  opaque  fluid,  and  was  surrounded  by  an  efflorescence 
of  a  dusky  red  colour  to  the  extent  of  one-third  part  of  an  inch. 
Such  an  intolerable  itching  was  excited,  that  the  boy  (who  was 
only  three  years  old)  could  not  be  prevented  from  rubbing  it. 
This  appearance  led  me  to  an  examination;  and  on  the  child’s 
head  I  observed  an  herpetic  blotch  not  much  larger  in  circum¬ 
ference  than  a  shilling.  The  hair  around  the  part  was  stiffened 
by  the  concreted  ichor  oozing  from  the  sore,  which  had  made 
its  appearance  about  ten  days.  No  eruption  showed  itself  in 
any  other  part  of  the  body.  The  pustule  was  repeatedly  broken 
by  the  child’s  scratching  and  rubbing  it;  and  the  inflammation 
on  the  arm,  which  began  to  spread  so  early,  on  the  eighth  and 
ninth  day  became  very  extensive.  T  he  child,  at  the  same  time, 
was  hot  and  restless.  A  soft,  amber-coloured  scab*  now  began 
to  form;  but  this  being  rubbed  off,  the  part  ulcerated  and  heal¬ 
ed  slowly,  leaving  a  cicatrix  deeper  and  larger  than  in  ordina¬ 
ry  cases.  The  disease  on  the  scalp  was  now  quickly  subdued 
by  the  use  of  tar  ointment;  and  at  the  expiration  of  six  weeks 
from  its  commencement,  the  inoculation  was  repeated,  when 
the  pustule  went  through  all  its  proper  stages  with  perfect  re¬ 
gularity.  The  rest  of  the  children  inoculated  at  the  same  time, 
went  through  the  cow-pox  in  the  ordinary  way,  without  any 
irregular  appearance. 

I  have  selected  this  case,  to  show  how  slight  a  local  appear¬ 
ance  may  produce  a  change  in  the  state  of  the  skin,  at  a  dis¬ 
tance  from  it.  I  cannot  call  it  a  general  change  in  every  case, 
as  I  have  sometimes  found  a  correct  pustule  on  one  arm,  and  a 
spurious  pustule  on  the  other;  indeed,  I  have  sometimes  found 
the  perfect  and  imperfect  pustule  on  the  same  arm,  within  two 

*  It  may  be  remarked,  that  purulent  matter  cannot  form  a  scab  so  hard  and 
compact  as  limpid  matter.  Hence  arises  the  difference  between  the  vario¬ 
lous  and  the  vaccine  scab.  It  accounts  too  for  the  varicellous  scab  being  com¬ 
monly  harder  than  the  variolous. 


19 


inches  of  each  other,  when  the  virus  inserted  was  taken  the 
same  instant  from  the  same  perfect  pustule.  It  happens  that  I 
more  frequently  detect  the  disease  by  the  appearance  of  the 
arm,  than  previously  to  inoculation.  Parental  fondness  is 
often  mismanaged,  and  induces  mothers  to  conceal  eruptive 
complaints  on  their  children. 

These  are  the  constitutions  which  sometimes  show  a  few 
wandering  pustulous  eruptions  after  Vaccine  inoculation;  and 
so  peculiarly  irritable  is  the  skin  when  influenced  by  herpes, 
that  the  smallest  wound,  a  slight  scratch,  or  the  pricking  of  a 
pin,  for  example,  commonly  produces  inflammation,  and  slight, 
superficial  suppuration. 

The  preceding  year  I  inoculated  another  child  at  Chelten¬ 
ham,  whose  face  was  involved  in  one  general  thick  incrusta¬ 
tion.  She  had  been  in  this  state,  without  any  material  varia¬ 
tion,  upwards  of  two  years,  during  which  time  many  applica¬ 
tions  had  been  used  to  no  purpose.  The  scalp  partook,  in  some 
degree,  of  the  same  kind  of  disease;  but  the  body  and  limbs 
were  free  from  it,  except  when  any  of  the  acrid  fluid,  oozing 
from  fissures  in  the  crust,  chanced  to  fall  upon  the  neck  or 
breast;  it  then  invariably  produced,  for  a  time,  a  similar  ap¬ 
pearance.  On  vaccinating  this  child  by  a  single  puncture  in 
each  arm,  the  pustules  went  through  their  course  correctly. 
On  their  decline,  the  incrustation  began  to  be  less  coherent, 
and  to  drop  off;  and  at  the  expiration  of  a  fortnight,  the  face 
was  smooth,  no  vestige  of  the  disease  remaining,  except  a 
slight  inflammation  of  the  eye-lids. 

Cases  of  this  sort  have  become  familiar;  Mr.-Ring  has  given 
several  in  his  very  copious  Treatise  on  the  Cow-pox;  and  they 
have  been  mentioned  by  other  authors,  both  here  and  on  the 
Continent. 

I  have  in  like  manner  sometimes  seen  papulous  eruptions, 
which  have  long  proved  troublesome,  speedily  swept  away. 

This  I  think  may  be  accounted  for.  The  vaccine  virus,  a 
few  days  after  its  insertion,  begins  to  act  upon  the  constitution. 
It  is  then  manifest,  from  a  new  appearance  which  these  erup¬ 
tions  put  on,  commonly  that  of  increased  inflammation,  that  a 
new  action  has  been  excited  in  them.  The  original  morbid  ac¬ 
tion  therefore  becomes  deranged  and  is  destroyed,  and  conse¬ 
quently  the  disease  is  conquered.  I  have  seen  many  instances 
where  pre-existing  pimples  have  been  converted  into  vaccine 
pocks,  which  have  kept  pace  with  those  on  the  arms  in  their 
progressive  changes. 

Seeing  that  the  skin,  when  disposed  to  reject  the  ordinary 


20 


action  of  the  variolous  virus,  rejects  the  vaccine  also,  I  shall 
just  observe;  it  occurs  to  me  as  probable,  that  its  herpetic 
state,  at  the  time  of  inoculation,  has  been  the  chief  source  of 
those  failures,  which  many  practitioners  have  witnessed  in 
inoculating  for  the  small-pox:  for  in  many  instances  where,  on 
subsequent  exposure  to  infection,  the  disease  has  been  taken, 
it  has  been  found  that  the  process  of  inflammation  and  suppu¬ 
ration  on  the  arms  had  gone  to  a  greater  extent  than  in  ordi¬ 
nary  cases,  that  the  symptomatic  affections  were  clearly  mark¬ 
ed,  and  that  even  eruptions,  though  small  and  seldom  maturat¬ 
ing,  have  appeared.  But  as  the  state  of  the  arm  became  a  se¬ 
condary  object  in  inoculating  for  the  small-pox,  our  solicitude 
being  directed  to  what  appeared  of  far  more  consequence,  the 
number  of  pustules,  I  almost  despair  of  obtaining  much  infor¬ 
mation  on  this  point.  , 

I  shall  conclude  this  paper  by  observing,  that  although  the 
Vaccine  Inoculator  does  not  inflict  a  severe  disease,  but, on  the 
contrary,  produces  a  mild  affection  scarcely  meriting  that  term, 
yet,  nevertheless,  he  should  be  extremely  careful  to  obtain  a 
just  and  clear  conception  of  this  important  branch  of  medical 
science.  He  should  not  only  be  acquainted  with  the  laws  and 
agencies  of  the  vaccine  virus  on  the  constitution,  but  with 
those  of  the  variolous  also,  as  they  often  interfere  with  each 
other. 

A  general  knowledge  of  the  subject  is  not  sufficient  to  ena¬ 
ble  or  to  warrant  a  person  to  practice  Vaccine  Inoculation; 
he  should  possess  a  particular  knowledge;  and  that  which  I 
would  wish  strongly  to  inculcate,  as  the  great  foundation  of 
the  whole,  is  an  intimate  acquaintance  with  the  character  of 
the  true  and  genuine  vaccine  pustule.  The  spurious  pustule 
would  then  be  readily  detected,  whatever  form  it  might  as¬ 
sume;  and  errors  known  no  htore. 

I  am,  &c. 

EDWARD  JENNER. 

Berkeley,  July  15,  1804, 


t 


